RESUMEN
BACKGROUND: Vancomycin-resistant Enterococcus faecium (VRE) may cause outbreaks in neonatal intensive care units (NICU). We describe a biphasic VRE outbreak and identify risk factors for VRE acquisition. METHODS: After the occurrence of 2 cases of VRE infections in a 44-bed NICU, a bundle of interventions was implemented that included active surveillance cultures for VRE, enhanced infection control measures, and audits on antimicrobial use, from June to December 2008. Analysis was performed using polymerase chain reaction and pulse-field gel electrophoresis techniques. A case-control study was conducted to identify risk factors. RESULTS: Among 253 neonates screened, 101 (39.9%) were found to be colonized with VRE. During the first 9 weeks of the study period, 59 new cases were detected. Molecular analysis showed 1 predominant clone. During weeks 10-12, no new cases of VRE colonization were detected; however, at week 13, just when the outbreak appeared to be over, a second wave occurred, with 42 new cases and multiple clones detected. Multivariate analysis identified administration of antimicrobial therapy for late-onset neonatal sepsis and hospitalization during the first month of this outbreak as significant risk factors for VRE colonization. CONCLUSION: Both a high prevalence of VRE colonization and antimicrobial use promoted the transmission of VRE during this biphasic outbreak. Adherence to infection control measures and antimicrobial stewardship policies are of utmost importance.
Asunto(s)
Brotes de Enfermedades , Enterococcus faecium/clasificación , Enterococcus faecium/efectos de los fármacos , Infecciones por Bacterias Grampositivas/epidemiología , Resistencia a la Vancomicina , Antibacterianos/uso terapéutico , Estudios de Casos y Controles , ADN Bacteriano/genética , Utilización de Medicamentos/estadística & datos numéricos , Electroforesis en Gel de Campo Pulsado , Enterococcus faecium/genética , Enterococcus faecium/aislamiento & purificación , Femenino , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Recién Nacido , Cuidado Intensivo Neonatal , Masculino , Epidemiología Molecular , Tipificación Molecular , Reacción en Cadena de la Polimerasa , Factores de RiesgoRESUMEN
We present a polyclonal outbreak of vancomycin-resistant enterococci (VRE) colonization in a pediatric oncology department and the role of a bundle of actions. After the occurrence of VRE bloodstream infections in 2 patients, an active surveillance of VRE colonization was started. Enhanced infection control measures and closure of the department to new admissions for the first 3 months were implemented. Among 32 patients screened for VRE, 21 were found colonized. Daily prevalence of VRE colonization among hospitalized patients ranged from 40% to 75%, but no new VRE infections occurred. Monthly incidence of VRE colonization decreased from 2.5 to 0.6 cases per 100 occupied bed-days at the end of this outbreak by the implementation of the above-mentioned measures. All VRE isolates tested were Enterococcus faecium carrying VanA gene. Pulsed field gel electrophoresis showed a polyclonal outbreak. A case-control study did not show any particular risk factors for colonization. High use of glycopeptide was noted before study outbreak that was drastically decreased during the study but only temporarily. Control of VRE in pediatric oncology departments with high colonization rates is challenging and requires a multifaceted strategy. Polyclonal spread of VRE found in this study suggests a possible effect of prior antimicrobial overuse and the critical need for antimicrobial stewardship especially in the era of multidrug-resistant bacteria.
Asunto(s)
Infección Hospitalaria/epidemiología , Brotes de Enfermedades , Enterococcus faecium/efectos de los fármacos , Infecciones por Bacterias Grampositivas/epidemiología , Resistencia a la Vancomicina , Estudios de Casos y Controles , Niño , Infección Hospitalaria/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Humanos , Oncología Médica , Estudios RetrospectivosAsunto(s)
Infecciones Bacterianas/microbiología , Enterobacter cloacae/aislamiento & purificación , Escherichia coli/aislamiento & purificación , Klebsiella pneumoniae/aislamiento & purificación , Infección de Heridas/microbiología , Antibacterianos/farmacología , Carbapenémicos/farmacología , Enterobacter cloacae/efectos de los fármacos , Escherichia coli/efectos de los fármacos , Grecia , Humanos , Klebsiella pneumoniae/efectos de los fármacos , Pruebas de Sensibilidad Microbiana , beta-Lactamasas/metabolismoRESUMEN
The accurate phenotypic detection of Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae is an increasing necessity worldwide. We evaluated the performance of boronic acid combined-disk tests using as substrate imipenem or meropenem and as inhibitor of KPC production 300 µg aminophenylboronic acid (APBA), 600 µg APBA, or 400 µg phenylboronic acid (PBA). Tests were considered positive when an increase in the growth-inhibitory zone around a carbapenem disk with KPC inhibitor was 5 mm or greater of the growth-inhibitory zone diameter around the disk containing carbapenem alone. The comparison of the combined-disk tests was performed with 112 genotypically confirmed KPC-possessing Enterobacteriaceae isolates. To measure the specificity of the tests, 127 genotypically confirmed KPC-negative Enterobacteriaceae isolates that were nonsusceptible to at least one carbapenem were chosen for testing. Using disks containing imipenem without and with 300 µg APBA, 600 µg APBA, or 400 µg PBA, 72, 92, and 112 of the KPC producers, respectively, gave positive results (sensitivities, 64.3%, 82.1%, and 100%, respectively). Using disks containing meropenem without and with 300 µg APBA, 600 µg APBA, or 400 µg PBA, 87, 108, and 112 of the KPC producers, respectively, gave positive results (sensitivities, 77.7%, 96.4%, and 100%, respectively). Among KPC producers, the disk potentiation tests using meropenem and PBA demonstrated the largest differences in inhibition zones (P < 0.001). All combined-disk tests correctly identified 124 of the 127 non-KPC producers (specificity, 97.6%). This comparative study showed that PBA is the most effective inhibitor of KPC enzymes, and its use in combined-disk tests with meropenem may give the most easily interpreted results.
Asunto(s)
Antibacterianos/farmacología , Proteínas Bacterianas/metabolismo , Ácidos Borónicos/metabolismo , Enterobacteriaceae/enzimología , beta-Lactamasas/metabolismo , beta-Lactamas/farmacología , Infecciones por Enterobacteriaceae/microbiología , Genotipo , Humanos , Imipenem/farmacología , Meropenem , Pruebas de Sensibilidad Microbiana/métodos , Fenotipo , Sensibilidad y Especificidad , Tienamicinas/farmacologíaAsunto(s)
Antibacterianos/farmacología , Proteínas Bacterianas/biosíntesis , Colistina/farmacología , Farmacorresistencia Bacteriana , Klebsiella pneumoniae/efectos de los fármacos , Klebsiella pneumoniae/enzimología , beta-Lactamasas/biosíntesis , Humanos , Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/aislamiento & purificaciónRESUMEN
The outcome of patients with urinary tract infections caused by extended spectrum ß-lactamases (ESBL)-producing bacteria (cases) was compared with that of matched controls with urinary tract infections caused by non-extended spectrum ß-lactamases-producing isolates. Significantly, more case patients received inappropriate empiric therapy than controls. Nevertheless, clinical and microbiologic outcomes as well as formation of renal scars did not differ between the 2 groups.
Asunto(s)
Antibacterianos/administración & dosificación , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Infecciones por Enterobacteriaceae/microbiología , Enterobacteriaceae/enzimología , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiología , beta-Lactamasas/metabolismo , Antibacterianos/farmacología , Estudios de Casos y Controles , Niño , Preescolar , Enterobacteriaceae/aislamiento & purificación , Femenino , Humanos , Lactante , Masculino , Resultado del Tratamiento , Resistencia betalactámicaRESUMEN
OBJECTIVE: To determine risk factors for bloodstream infections (BSIs) caused by Klebsiella pneumoniae producing metallo-ß-lactamases (MBLs) or K. pneumoniae carbapenemases (KPCs), as well as risk factors for mortality associated with carbapenem-resistant K. pneumoniae, among intensive care unit (ICU) patients. METHODS: Two case-control studies were conducted in a patient cohort with K. pneumoniae BSIs in an 8-bed ICU in a Greek hospital from January 1, 2007, through December 31, 2008. In study 1, patients with K. pneumoniae BSIs were allocated among 3 groups according to isolate susceptibility profile: (1) carbapenem-susceptible insolates (control group), (2) MBL-producing isolates, or (3) KPC-producing isolates. The MBL and KPC groups were compared with the control group to identify risk factors for development of K. pneumoniae BSI. In study 2, patients with K. pneumoniae BSIs who died were compared with survivors to identify risk factors for mortality. RESULTS: Fifty-nine patients had K. pneumoniae BSIs (22 with carbapenem-susceptible isolates, 18 with MBL-producing isolates, and 19 with KPC-producing isolates). All KPC-producing isolates carried the bla(KPC-2) gene, and 17 of 18 MBL-producing isolates carried bla(VIM-1). Acute Physiology and Chronic Health Evaluation II score (odds ratio, 1.13 [95% confidence interval, 1.03-1.25]; [Formula: see text]) was independently associated with KPC-producing K. pneumoniae BSIs. Nine (41%) of 22 control patients, 8 (44%) of 18 MBL group patients, and 13 (68%) of 19 KPC group patients died in the ICU. Nine (41%) of 22 control patients, 10 (56%) of 18 MBL group patients, and 15 (79%) of 19 KPC group patients died in the hospital. Isolation of KPC-producing K. pneumoniae was an independent predictor of ICU death ([Formula: see text]) and in-hospital death ([Formula: see text]) but not infection-attributable death. CONCLUSIONS: BSIs due to KPC-producing K. pneumoniae resulted in significantly increased mortality. The accurate and rapid detection of these pathogens is necessary for therapeutic considerations and for the implementation of infection control measures to contain them.
Asunto(s)
Antibacterianos/farmacología , Proteínas Bacterianas/farmacología , Infección Hospitalaria/microbiología , Infecciones por Klebsiella/tratamiento farmacológico , Infecciones por Klebsiella/mortalidad , Klebsiella pneumoniae/efectos de los fármacos , beta-Lactamasas/farmacología , APACHE , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bacteriemia/microbiología , Bacteriemia/mortalidad , Proteínas Bacterianas/metabolismo , Carbapenémicos/farmacología , Estudios de Casos y Controles , Infección Hospitalaria/mortalidad , Farmacorresistencia Bacteriana , Farmacorresistencia Bacteriana Múltiple , Femenino , Grecia/epidemiología , Humanos , Unidades de Cuidados Intensivos , Klebsiella pneumoniae/enzimología , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/aislamiento & purificación , Masculino , Metaloproteínas , Persona de Mediana Edad , Análisis Multivariante , Reacción en Cadena de la Polimerasa , Factores de Riesgo , Resultado del Tratamiento , Adulto Joven , beta-Lactamasas/genética , beta-Lactamasas/metabolismoRESUMEN
BACKGROUND: The increasing frequency of class A KPC enzymes and class B metallo-beta-lactamases (MBLs) among Enterobacteriaceae as well as their possible co-production makes their early differentiation urgent. METHODS: A simple phenotypic algorithm employing three combined-disc tests consisting of meropenem alone and with phenylboronic acid (PBA), EDTA, or both PBA and EDTA was designed for the differentiation of KPC and MBL enzymes. Augmentation of the zone of inhibition by >or=5 mm was considered a positive combined-disc test result. A total of 141 genotypically confirmed carbapenemase-positive Enterobacteriaceae clinical isolates (63 KPC producers, 47 MBL producers, and 31 KPC and MBL producers) with various carbapenem MICs were examined. For comparison, 84 genotypically confirmed carbapenemase-negative Enterobacteriaceae clinical isolates [39 extended-spectrum beta-lactamase (ESBL) producers, 22 AmpC producers, and 23 ESBL and AmpC producers] were also tested. RESULTS: The phenotypic algorithm was able to differentiate MBL from KPC producers as well as to detect the possible co-production of both carbapenemases (positive result only with the combined-disc test using meropenem alone and with both PBA and EDTA). The method detected all KPC or MBL producers (sensitivity 100%) as well as 30 of the KPC and MBL producers (sensitivity 96.8%). All three combined-disc tests were negative for non-carbapenemase-producing isolates, except two ESBL and AmpC producers that gave positive combined-disc tests using meropenem alone and with PBA and both PBA and EDTA (specificity for KPC detection 98.8%). CONCLUSIONS: This phenotypic method is very helpful to detect carbapenemase production and provides a simple algorithm for the differentiation of KPC and MBL enzymes, especially in regions where KPC- and MBL-possessing Enterobacteriaceae are highly prevalent.
Asunto(s)
Antibacterianos/farmacología , Infecciones por Enterobacteriaceae/microbiología , Enterobacteriaceae/enzimología , beta-Lactamasas/biosíntesis , beta-Lactamasas/clasificación , beta-Lactamas/farmacología , Enterobacteriaceae/aislamiento & purificación , Humanos , Pruebas de Sensibilidad Microbiana , Sensibilidad y EspecificidadRESUMEN
We evaluated boronic acid (BA)-based methods for their ability to detect extended-spectrum beta-lactamases (ESBLs) among clinical isolates of KPC-producing members of the Enterobacteriaceae family. A total of 155 isolates of Klebsiella pneumoniae (n = 141), Escherichia coli (n = 6), Enterobacter aerogenes (n = 6), and Klebsiella oxytoca (n = 2) genotypically confirmed to be KPC producers were analyzed. As many as 118 isolates harbored ESBLs (103 harbored SHV-type ESBLs, 13 harbored CTX-M-type ESBLs, and 2 harbored both SHV- and CTX-M-type ESBLs); the remaining 37 isolates were genotypically negative for ESBL production. The CLSI ESBL confirmatory test was positive for 79 of the 118 ESBL producers (sensitivity, 66.9%), while all 37 non-ESBL producers were negative (specificity, 100%). When a > or =5-mm increase in the zone diameter of either the cefotaxime (CTX)-clavulanate (CA) or the ceftazidime (CAZ)-CA disks containing BA compared with the zone diameter of the CTX or CAZ disks containing BA was considered to be a positive result for ESBL production, the method detected all 118 ESBL producers (sensitivity, 100%) and showed no false-positive results for non-ESBL producers (specificity, 100%). Double-disk synergy tests, in which disks of CTX, CAZ, aztreonam, or cefepime in combination with BA were placed at distances of 20, 25, and 30 mm (center to center) from a disk containing amoxicillin (amoxicilline)-clavulanate-BA, were able to detect 116 (98.3%), 101 (85.6%), and 28 (23.7%) of the ESBL-positive isolates, respectively; no false-positive results for non-ESBL-producing isolates were detected. Our results demonstrate that the modified CLSI ESBL confirmatory test with antibiotic disks containing BA is the most accurate phenotypic method for the detection of ESBLs in Enterobacteriaceae producing KPC carbapenemases.
Asunto(s)
Proteínas Bacterianas/análisis , Ácidos Borónicos/farmacología , Enterobacteriaceae/enzimología , Inhibidores Enzimáticos/farmacología , Pruebas de Sensibilidad Microbiana/métodos , beta-Lactamasas/análisis , Antibacterianos/farmacología , Proteínas Bacterianas/antagonistas & inhibidores , ADN Bacteriano/genética , Errores Diagnósticos , Enterobacteriaceae/efectos de los fármacos , Enterobacteriaceae/genética , Enterobacteriaceae/aislamiento & purificación , Infecciones por Enterobacteriaceae/microbiología , Humanos , Sensibilidad y Especificidad , Inhibidores de beta-Lactamasas , beta-Lactamasas/genéticaRESUMEN
OBJECTIVES: KPC-possessing Klebsiella pneumoniae have been found to be widespread in several regions but are still rarely detected in Europe. We describe the characteristics of an outbreak caused by KPC producers in a tertiary care Greek hospital. METHODS: During a 12 month period (October 2007-September 2008), 47 patients in Hippokration University Hospital yielded K. pneumoniae isolates that exhibited reduced susceptibility to carbapenems and were phenotypically positive for carbapenemase production but negative for metallo-beta-lactamase (MBL) production. Single patient isolates were tested by Vitek 2, Etest, agar dilution MICs, phenotypic assays and PFGE. Carbapenemase and other beta-lactamase genes were identified by PCR and sequencing. Patient records were retrospectively reviewed to access co-morbidities, antibiotic exposure prior to infection and outcome. RESULTS: The 47 K. pneumoniae isolates exhibited various susceptibilities to imipenem and meropenem; all were non-susceptible to ertapenem and several other antibiotics but most were susceptible to gentamicin, colistin and tigecycline. PFGE classified the isolates into two clonal types, with the predominant type, which was closely related to that of hyperepidemic strains from the USA and Israel, comprising three subtypes. All isolates carried the bla(KPC-2) gene; 45 also carried bla(SHV-12) and 29 bla(TEM-1). Patients were hospitalized in nine different units. The median length of hospital stay prior to KPC isolation was 21 days; 38 patients (80.9%) had evidence of clinical infection due to a KPC producer and 16 (34%) had bacteraemia. The crude mortality rate was 27.7%. A beta-lactam/beta-lactamase inhibitor combination was the most frequently administered antimicrobial prior to KPC isolation (20 patients; 42.5%), whereas only nine patients (19.1%) had prior carbapenem use. CONCLUSIONS: This study presents for the first time a wide intrahospital spread of KPC-producing K. pneumoniae clones in a European hospital. The KPC producers were rapidly disseminated in several units, indicating the difficulty in restraining such multidrug-resistant clones when they have been established in a hospital environment.
Asunto(s)
Brotes de Enfermedades , Farmacorresistencia Bacteriana Múltiple , Infecciones por Klebsiella/epidemiología , Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/enzimología , beta-Lactamasas/biosíntesis , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/farmacología , Técnicas de Tipificación Bacteriana , Análisis por Conglomerados , Dermatoglifia del ADN , ADN Bacteriano/genética , Electroforesis en Gel de Campo Pulsado , Femenino , Genotipo , Grecia/epidemiología , Humanos , Klebsiella pneumoniae/clasificación , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/aislamiento & purificación , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa/métodos , Análisis de Secuencia de ADN , beta-Lactamasas/genéticaRESUMEN
A study was designed to investigate the molecular epidemiological characteristics of multidrug-resistant outbreak-related Pseudomonas aeruginosa isolates collected in a university hospital in northern Greece. Of 29 nonreplicate P. aeruginosa isolates resistant to carbapenems and ceftazidime, 14 were positive for metallo-beta-lactamase production. PCR analyses with primers specific for bla(VIM) and bla(IMP) revealed that 13 isolates carried a novel bla(VIM-2) gene variant, designated bla(VIM-17), and only 1 isolate carried bla(VIM-2), a gene predominant among P. aeruginosa strains in Greek hospitals. Pulsed-field gel electrophoresis of XbaI-digested genomic DNAs showed a close genetic relationship for 12 of 13 bla(VIM-17)-carrying outbreak-related isolates, which were of the O11 serotype; the clonally unrelated isolate carrying bla(VIM-17) was of the O12 serotype. PCR mapping strategies for the detection of class 1 integrons and sequencing approaches revealed the presence of integrons containing one bla(VIM) cassette flanked by two aacA29 cassettes. These integrons were similar but not identical to In59 (GenBank accession number AF263519) initially described in France. All isolates carrying bla(VIM-17), regardless of their genetic profile, had an identical integron, named In59.3, indicating that although the hospital outbreak was mainly due to clonal dissemination, the horizontal transmission of the bla(VIM-17)-containing integron among P. aeruginosa isolates should also have occurred. An outbreak-related isolate and a control strain, both of which carried the bla(VIM-2) gene but which were clonally distinct, had an identical integron, named In59.2, which differed only at the level of the bla(VIM) gene from In59.3 integrons, suggesting a common ancestry. The spread of the bla(VIM-17)-containing integron in clonally unrelated P. aeruginosa isolates without any evidence of plasmid carriage is probably associated with a transposon.
Asunto(s)
Brotes de Enfermedades , Infecciones por Pseudomonas/epidemiología , Pseudomonas aeruginosa/genética , beta-Lactamasas/genética , Electroforesis en Gel de Campo Pulsado , Genotipo , Humanos , Unidades de Cuidados Intensivos , Fenotipo , Regiones Promotoras Genéticas , Pseudomonas aeruginosa/enzimologíaRESUMEN
The worldwide increase in the occurrence and dissemination of KPC beta-lactamases among gram-negative pathogens makes critical the early detection of these enzymes. Boronic acid disk tests using different antibiotic substrates were evaluated for detection of KPC-possessing Klebsiella pneumoniae isolates. A total of 57 genotypically confirmed KPC-possessing K. pneumoniae isolates with varying carbapenem MICs were examined. To measure the specificity of the tests, 106 non-KPC-possessing isolates (89 K. pneumoniae and 17 Escherichia coli isolates) were randomly selected among those exhibiting reduced susceptibility to cefoxitin, expanded-spectrum cephalosporins, or carbapenems. As many as 56, 53, and 40 of the non-KPC-possessing isolates harbored extended-spectrum beta-lactamases, metallo-beta-lactamases, and plasmid-mediated AmpC beta-lactamases, respectively. By use of CLSI methodology and disks containing imipenem, meropenem, or cefepime, either alone or in combination with 400 microg of boronic acid, all 57 KPC producers gave positive results (sensitivity, 100%) whereas all 106 non-KPC producers were negative (specificity, 100%). The meropenem duplicate disk with or without boronic acid demonstrated the largest differences in inhibition zone diameters between KPC producers and non-KPC producers. By use of disks containing ertapenem, all isolates were correctly differentiated except for five AmpC producers that gave false-positive results (sensitivity, 100%; specificity, 95.3%). These practical and simple boronic acid disk tests promise to be very helpful for the accurate differentiation of KPC-possessing K. pneumoniae isolates, even in regions where different broad-spectrum beta-lactamases are widespread.
Asunto(s)
Técnicas Bacteriológicas/métodos , Ácidos Borónicos/metabolismo , Klebsiella pneumoniae/química , Klebsiella pneumoniae/enzimología , beta-Lactamasas/análisis , Antibacterianos/farmacología , Reacciones Falso Positivas , Humanos , Klebsiella pneumoniae/efectos de los fármacos , Klebsiella pneumoniae/aislamiento & purificación , Pruebas de Sensibilidad Microbiana/métodos , Sensibilidad y Especificidad , Resistencia betalactámica , beta-Lactamas/farmacologíaRESUMEN
OBJECTIVE: To investigate whether there is a correlation between the rates of antimicrobial drug consumption in hospital departments and the prevalence of antimicrobial resistance among clinically important bacteria recovered in the hospital. DESIGN: Retrospective study. SETTING: Tertiary care hospital in Greece. METHODS: Data on antimicrobial consumption (from January 2001 through December 2004) were expressed as defined daily doses per 100 bed-days. The prevalence of antimicrobial resistance among isolates of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterococcus faecium recovered during the same time period were calculated by the microbiology department. We then performed the following analyses: (1) a comparison of the consumption rates for different antimicrobial groups in individual hospital departments, (2) a comparison of the prevalence of resistance to different antimicrobials, and (3) a correlation analysis of antimicrobial consumption rates and the prevalence of antimicrobial resistance. RESULTS: The rates of antimicrobial consumption and the prevalence of resistance varied substantially among the hospital's departments. The annual rate of consumption for carbapenems correlated with the rate of consumption for glycopeptides and third-generation cephalosporins (P < .05). Among P. aeruginosa isolates, the prevalence of imipenem resistance correlated with the prevalence of resistance to amikacin, ciprofloxacin, and ceftazidime (P < .05). The rate of carbapenem consumption correlated with the prevalence of imipenem resistance among P. aeruginosa and A. baumannii isolates (P < .05). The rate of aminoglycoside consumption correlated with the prevalence of amikacin resistance among P. aeruginosa, K. pneumoniae, and E. coli isolates (P < .05). However, the rate of consumption for fluoroquinolones and glycopeptides had no correlation with the prevalence of ciprofloxacin resistance among gram-negative bacteria or vancomycin resistance among E. faecium isolates. CONCLUSIONS: These data are suggestive of a differential relationship between antimicrobial consumption and the prevalence of antimicrobial resistance among various species and for various antimicrobial agents. These findings may help to optimize antimicrobial prescription policies in the hospital, especially in departments that have both high rates of antimicrobial consumption and a high prevalence of antimicrobial resistance.
Asunto(s)
Antibacterianos/uso terapéutico , Farmacorresistencia Bacteriana , Enterococcus faecium/efectos de los fármacos , Bacterias Gramnegativas/efectos de los fármacos , Infecciones por Bacterias Gramnegativas/epidemiología , Infecciones por Bacterias Grampositivas/epidemiología , Departamentos de Hospitales/estadística & datos numéricos , Adulto , Antibacterianos/farmacología , Niño , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Bacterias Gramnegativas/clasificación , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/microbiología , Grecia , Hospitales , Humanos , Pruebas de Sensibilidad Microbiana , PrevalenciaAsunto(s)
Antibacterianos/farmacología , Proteínas Bacterianas/biosíntesis , Enterobacteriaceae/efectos de los fármacos , Metaloproteínas/biosíntesis , Minociclina/análogos & derivados , beta-Lactamasas/biosíntesis , Enterobacteriaceae/clasificación , Enterobacteriaceae/enzimología , Infecciones por Enterobacteriaceae/microbiología , Humanos , Pruebas de Sensibilidad Microbiana , Minociclina/farmacología , Tigeciclina , Resistencia betalactámicaAsunto(s)
Escherichia coli/enzimología , Escherichia coli/aislamiento & purificación , Recombinación Genética , beta-Lactamasas/biosíntesis , beta-Lactamasas/genética , Anciano de 80 o más Años , Antibacterianos/farmacología , Conjugación Genética , Escherichia coli/efectos de los fármacos , Escherichia coli/genética , Infecciones por Escherichia coli/virología , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , PlásmidosRESUMEN
A prospective study was conducted to determine risk factors for fungal colonization, drug susceptibility, and association with invasive fungal infections (IFIs) in a neonatal unit. On admission and weekly thereafter, surveillance fungal cultures were taken from mouth, rectum, and trachea of neonates with expected stays of > 1 week. Fungal colonization was detected in 72 (12.1%) of 593 neonates during 12 months. CANDIDA ALBICANS was isolated from 42% of colonized neonates. Although early colonization (age 1.3 +/- 0.2 days) was found in 2.5% of the neonates, late colonization (age 17.6 +/- 1.4 days) was noted in 14.2% of neonates hospitalized for > 5 days. Neonates born vaginally were at higher risk for early colonization than those delivered after cesarean section ( P = 0.01). By multivariate logistic regression, very low birthweight was the only independent risk factor for late colonization. Ten IFIs (nine candidemias) were diagnosed, yielding a rate of 1.1%. These episodes occurred in 6.9% of colonized neonates, compared with 0.76% of noncolonized neonates ( P = 0.002). C. ALBICANS was susceptible to azoles, but some non- ALBICANS CANDIDA spp. exhibited decreased susceptibility to these drugs.
Asunto(s)
Infección Hospitalaria/epidemiología , Unidades de Cuidado Intensivo Neonatal , Micosis/epidemiología , Candidiasis/epidemiología , Cesárea , Femenino , Humanos , Recién Nacido , Masculino , Boca/microbiología , Estudios Prospectivos , Recto/microbiología , Factores de Riesgo , Factores de Tiempo , Tráquea/microbiologíaRESUMEN
OBJECTIVE: To investigate the risk factors associated with nosocomial acquisition of imipenem-resistant Acinetobacter baumannii (IRAB) among pediatric intensive care patients. A retrospective case control study was conducted in a pediatric intensive care unit (PICU). PATIENTS AND PARTICIPANTS: Cases were children in whom IRAB was isolated from any clinical specimen obtained at least 48 h following admission to PICU. Controls were children without IRAB matched to cases in 2:1 ratio. Twenty-six cases were matched with 52 controls according to the chronological order of admission. MEASUREMENTS AND RESULTS: Between July 2001 and December 2003, 52 (62%) of 84 clinical A. baumannii isolates were found nonsusceptible to imipenem (MIC > or = 8 microg/ml). Demographic variables, comorbid conditions, clinical picture at admission, invasive procedures, use of antimicrobials and other drugs were analyzed as potential risk factors. Use of carbapenems and other beta-lactams, aminoglycosides, ranitidine, mechanical ventilation, central venous or urinary catheters and length of stay in PICU were among the factors significantly associated with IRAB acquisition in the univariate analysis. By multivariate analysis, however, only aminoglycoside use and length of stay in the PICU were independent risk factors. CONCLUSIONS: Acquisition of IRAB by PICU patients was independently associated with aminoglycoside use and prolonged stay in the unit. Studies of evaluation of infection control policies need to be pursued.
Asunto(s)
Infecciones por Acinetobacter/tratamiento farmacológico , Acinetobacter baumannii/efectos de los fármacos , Antibacterianos/farmacología , Infección Hospitalaria/tratamiento farmacológico , Imipenem/farmacología , Infecciones por Acinetobacter/epidemiología , Infecciones por Acinetobacter/microbiología , Acinetobacter baumannii/aislamiento & purificación , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Niño , Preescolar , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Farmacorresistencia Bacteriana , Femenino , Grecia/epidemiología , Humanos , Unidades de Cuidado Intensivo Pediátrico , Tiempo de Internación/estadística & datos numéricos , Modelos Logísticos , Masculino , Estudios Retrospectivos , Factores de RiesgoRESUMEN
In 2004 and 2005, 5 metallo-beta-lactamase (MBL)-positive Acinetobacter baumannii isolates were found in 2 Greek hospitals. Isolates were unrelated and carried blaVIM-1 in a class 1 integron; bla(OXA-51-) and bla(OXA-58-like) carbapenemase genes were also detected. VIM-1 MBL in Acinetobacter spp. causes concern, given the increasing resistance of this species.
Asunto(s)
Infecciones por Acinetobacter/microbiología , Acinetobacter baumannii/efectos de los fármacos , Acinetobacter baumannii/enzimología , Acinetobacter baumannii/aislamiento & purificación , ADN Bacteriano/química , ADN Bacteriano/genética , Farmacorresistencia Bacteriana , Electroforesis en Gel de Campo Pulsado , Humanos , Pruebas de Sensibilidad Microbiana , Reacción en Cadena de la Polimerasa , beta-Lactamasas/metabolismoAsunto(s)
Antibacterianos/farmacología , Infección Hospitalaria/microbiología , Brotes de Enfermedades , Farmacorresistencia Bacteriana Múltiple , Enterococcus faecalis/efectos de los fármacos , Infecciones por Bacterias Grampositivas/microbiología , Ampicilina/farmacología , Infección Hospitalaria/epidemiología , Infecciones por Bacterias Grampositivas/epidemiología , Grecia , Hospitales Universitarios , Humanos , Imipenem/farmacología , Pruebas de Sensibilidad Microbiana , Penicilinas/farmacologíaRESUMEN
To examine the dissemination of CTX-M-type extended-spectrum beta-lactamases (ESBLs) in clinical isolates of Proteus mirabilis, 91 nonrepetitive ESBL-producing P. mirabilis were collected from infected patients in a tertiary Greek hospital during September, 2001, to May, 2004. A bla (CTX-M) gene was amplified in one isolate (strain A328), but bla (CTX-M) was not detected in any of the remaining ESBL producers. Sequencing results showed that P. mirabilis A328 produced a CTX-M-1 enzyme while PCR mapping of the genetic element carrying bla (CTX-M-1) revealed that the gene was located downstream of an ISEcp1B element. The cefotaxime resistance determinant was easily transferable and carried on a 70-kb plasmid. The emergence of CTX-M-1- producing P. mirabilis indicates the need for early recognition of such strains to be able to control their spread in our hospital and community environment.